Regional drivers represent two-thirds of fatalities on NSW roads but only one-third of the state's population, the roads minister said.
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Speaking at the launch of a new road safety campaign in Queanbeyan on Monday, NSW roads minister Melinda Pavey said country drivers are more willing to take risks on the road.
"We don't have the public transport choices that city people have, so people take the risk, they go, 'Yeah, but...'," Ms Pavey said.
"It's just too high [the road toll] … We've got to confront it. There's many approaches we have to take."
According to the Centre for Road Safety, of the 380 deaths on NSW roads in 2016, 252 of those were on country roads
Centre director Bernard Carlon said stats indicated mainly older men died on country roads, as opposed to the stereotype of risk-taking younger drivers.
"The bulk of the fatalities are men in their 30s, and 40s and 50s," Mr Carlon said.
As of November this year, of the 351 fatalities on NSW roads in 2017, 47 were people aged 30 - 39, 52 were aged between 40 - 49 and 48 were aged between 60 - 69.
"It tells us the number of middle-aged drivers, particularly men … are willing to take risks," he said.
He added 85 per cent of drug-affected drivers who died were on regional roads.
Deputy premier John Barilaro said in his electorate of Monaro, there had been 42 deaths over the past five years, with 198 seriously injured in crashes on the region's road.
"Today, it's about a public awareness campaign. It is about road infrastructure, it is about the quality of car, it's also about public awareness," Mr Barilaro said.
"A lot of country people push the boundaries. We need drivers to accept that there is an issue."
Sam Bailey was not wearing a seat belt before a crash left him a quadriplegic. He has become one of the public faces of the 'Save Country Lives on Country Roads' campaign.
"I was given a life sentence," Mr Bailey said.
Mr Bailey said if he could make every driver in NSW experience the emotional hurt of a crash, he believed it would stop the road toll.
"They need to see real stories," Mr Bailey said.
